An outbreak of cyclospoa, primarily impacting Texas, has been linked to fresh cilantro from the Puebla area of Mexico .
Cyclospora is a single cell parasite that causes an intestinal infection called cyclosporiasis. Cyclospora is spread by people ingesting food or water that was contaminated with feces from an infected individual. Humans are the only known host (unlike other parasites that have other animals hosts). It is not unlikely, however, to be passed from person-to-person, because it needs time (days to weeks) after being passed in a bowel movement (pooped) to become infectious for another person.
It is seen mainly in tropical or subtropical regions of the world but makes its way into the United States, via contaminated food, primarily imported fresh produce, or from people who travel to these areas. The symptoms take about a week to show up, and it is in the form of watery diarrhea, with frequent, sometimes explosive, bowel movements. (Other symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted.) Some people who are infected can be asymptomatic (no symptoms).
Texas Department of State Health Services
Cyclospora – August 28, 2014
The Cyclospora illness outbreak being investigated by DSHS and local health departments in Texas along with the federal Centers for Disease Control and Prevention and Food and Drug Administration appears to have ended. The number of new illnesses being reported has returned to background levels, and the investigation has linked the cases in four restaurant clusters to cilantro imported from Puebla, Mexico.
Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasite. The major symptom is watery diarrhea lasting a few days to a few months. Additional symptoms may include loss of appetite, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and a low fever. Symptoms may come and go multiple times over a period of weeks.
126 cases are considered part of the outbreak with an onset of illness after May 1 and no history of international travel within the two weeks before onset. Most cases occurred in June and July. However, it is unknown whether all illnesses are linked to cilantro. 166 total cyclosporiasis cases have been reported in Texas in 2014. Most of the cases are in residents of North Texas.
DSHS, in conjunction with local health departments, investigated four restaurant clusters in North Texas that included a total of 21 people who got ill. All 21 reported eating a food item from the restaurant containing cilantro within two weeks before becoming ill. A preliminary traceback investigation conducted by FDA and DSHS has identified Puebla, Mexico as the source of the cilantro that was served in all four restaurants. While the investigation has not found samples of cilantro contaminated with cyclospora, there is enough evidence to establish a strong epidemiological link between the illnesses and the cilantro. The state of Puebla was also identified as the source of fresh cilantro linked to a cyclosporiasis outbreak in 2013.
DSHS and local health departments continue to monitor for new cyclosporiasis cases.
CDC Investigation Report
Cyclosporiasis Outbreak Investigations — United States, 2014
Last Updated August 28, 2014 1:00 PM EDT
Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.
As of August 26, 2014 (5pm EDT), CDC had been notified of 304 ill persons with confirmed Cyclospora infection in 2014; of these, 207 ill persons from the following states had no history of international travel within two weeks before onset of illness: Arkansas, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Pennsylvania, New Jersey, New York (and New York City), Texas, Virginia, Wisconsin, and Washington.
Most (133; 64%) of the cases were reported from Texas.
Most (133; 64%) of the cases were reported in July 2014.
Most (176; 85%) of the illness onset dates occurred in June and July.
Among 183 persons with available information, 7 (4%) have reported being hospitalized. No deaths have been reported.
Among 204 persons with available information, ill persons range in age from 3 to 88 years, with a median age of 49 years.
Among 204 persons with available information, 115 (56%) of ill persons are female.
To date, 133 ill persons with Cyclospora infection have been reported among Texas residents who did not travel outside of the country within the two weeks before becoming ill.
Epidemiologic and traceback investigations conducted in Texas by state and local public health and regulatory officials and the FDA indicated that some illnesses among Texas residents were linked to fresh cilantro from Puebla, Mexico.
Reported cases of cyclosporiasis in Texas have returned to baseline levels in August; therefore, it is likely that the outbreak has ended.
Investigations are ongoing in other states.
To date, there is no evidence to suggest that any illnesses outside of Texas are linked to cilantro from Puebla, Mexico.
Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.
Consumers and retailers should always follow safe produce handling recommendations.
More information about Cyclospora can be found on CDC's Cyclospora pages.
What is Cyclospora?
Cyclospora cayetanensis is a parasite composed of one cell, too small to be seen without a microscope. This parasite causes an intestinal infection called cyclosporiasis.
How is Cyclospora spread?
Cyclospora is spread by people ingesting something - such as food or water - that was contaminated with feces (stool). Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another.
Who is at risk for Cyclospora infection?
People living or traveling in tropical or subtropical regions of the world may be at increased risk for infection because cyclosporiasis is endemic (found) in some countries in these zones. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce.
What are the symptoms of Cyclospora infection?
The time between becoming infected and becoming sick is usually about 1 week. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with Cyclospora do not have any symptoms.
How long can the symptoms last?
If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). It’s common to feel very tired.
What should I do if I think I might be infected with Cyclospora?
See your health care provider.
How is Cyclospora infection diagnosed?
Your health care provider will ask you to submit stool specimens to see if you are infected. You might be asked to submit more than one specimen from different days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, if indicated, your health care provider should specifically request testing for Cyclospora. In addition, your health care provider might have your stool checked for other organisms that can cause similar symptoms.
How is Cyclospora infection treated?
The recommended treatment is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim*, Septra*, or Cotrim*. People who have diarrhea should also rest and drink plenty of fluids.
I am allergic to sulfa drugs; is there another drug I can take?
No highly effective alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. See your health care provider to discuss potential options.
How is Cyclospora infection prevented?
Avoiding food or water that might have been contaminated with stool may help prevent Cyclospora infection. People who have previously been infected with Cyclospora can become infected again.